=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801055447
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MANISH PATEL MD PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/09/2008
-----------------------------------------------------
Last Update Date | 09/27/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 520 WESTFIELD AVE SUITE 306
-----------------------------------------------------
City | ELIZABETH
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07208-1658
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-994-1044
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 306 MAPLE HILL DR
-----------------------------------------------------
City | WOODBRIDGE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07095-4104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-994-1044
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. MANISH S PATEL
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 908-994-1044
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | MA074156
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------